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RESIDENTS' CORNER

DEVELOPING EVLP TO REPAIR DONOR ORGANS

Jonathan Yeung will start thoracic surgery residency in July of 2013. He has completed 4 years of clinical general surgery, and 4 years of surgical science, leading to a PhD in Shaf Keshavjee’s lab.

“It was serendipitous for me to work on the Ex - Vivo Lung Perfusion (EVLP) program. As a junior resident, Michael Johnston and Yaron Shargall redirected my interest to thoracic surgery. During a thoracic surgery elective, Shaf asked me to take a look at the ex vivo studies and ultimately gave me the ex vivo perfusion project for my thesis problem. I have been lucky to be part of the leading edge of that translational research. I got to see it move from studies in pigs to being the standard of care for human patients. Now people come from around the world to learn it.

“Clinical Donation after Cardiac Death (DCD) took off when I was in the lab. One of the reasons the lungs are ideal for DCD is that they can be ventilated during retrieval. Giving oxygen directly makes them more resilient during the time spent in a cardiac-arrested donor. The major theoretical advantage of DCD is that it avoids the cytokine and adrenergic storm of brain death. The disadvantage is that there is no good way to evaluate the lungs immediately prior to organ retrieval due to the lack of circulation. Placing the lungs on the EVLP circuit after they are retrieved provides a solution to this problem. While on the EVLP circuit, lung function can be assessed prior to making a final decision to implant them into a recipient. We found that evaluation based on PO2 isn’t entirely adequate due to the use of an acellular perfusate and so we defined physiologic evaluation parameters for use during EVLP. Even more importantly, we showed that EVLP could be paired with repair strategies such as gene therapy to improve the function of injured donor lungs. The take-away from this is that donation can be expanded because we can check all donor lungs, even those initially judged to be ‘too injured to utilize’. Those deemed ‘still too injured’ can be treated using specific ex vivo therapies tailored to those injuries.”

Yeung by water

Jonathan Yeung in Big Sur, California

Jonathan grew up in Calgary, where his father, a Hong Kong native, is a Professor of Plant Biology. As a math and science student, Jonathan initially chose to study biochemistry and did research with the Alberta Heritage Program on streptavidin-biotin interactions. His role models have been Michael Johnston, Yaron Shargall, and Shaf Keshavjee. He was encouraged by Ori Rotstein to get into research. His wife, Andrea Wan, is an interventional paediatric cardiologist. The latest book he read was The Art of Racing in the Rain by Garth Stein.

M.M.




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